Four years ago, Dr. Nick Edwards, a passionate NHS Supporter, published his book about working in A&E: In Stitches: The Highs and Lows of Life as an A&E Doctor. Now with new material, an updated second edition has recently been published.
Dr Edwards uses episodes of his everyday job to show what it is like working in the frontline of the NHS, but also to highlight potential problems of government reforms. In an extract from his book, this is highlighted with the case of a man who had superb care because the hospitals, GPs and health care workers were co-operating and not competing with each other. Can we afford to go down the marketisation route? This story shows why it may be a bad treatment for the NHS.
One of our patients, who has made me really happy, came in with an injured ankle. He was in his 50s, a builder by trade and an absolutely delightful man. He had come in after playing football with his 3-year old grandson. He slipped on the grass and got a small break to his fibula. An easy to treat fracture, which I was delighted he got.
The reason I was so happy was that he looked very familiar. I had been part of a team that treated him about four months previously. He had had an out of hospital cardiac arrest caused by a heart attack - his heart had stopped for 13 minutes and in essence he had died. A member of the public saw him collapse and immediately started chest compressions. The ambulance arrived and started his heart again using a defibrillator. When he arrived in the emergency department, I was in charge of his care. We gave special drugs to keep up his blood pressure, and we used special ice packs to cool down his body temp to protect his brain from the damage that had occurred to his body during the arrest. He went from us in A&E to the Cardiac Cath lab and had a stent placed to open up the blocked vessels. A bit like a plumber unblocking your drain. He went on to have a balloon pump placed in his aorta (largest blood vessel coming from the heart) to help keep up his blood pressure. He went from there to the Intensive Care Unit, where he was kept alive by dialysis despite his kidneys failing. From there he went back to the cardiology unit where he had a pacemaker fitted which not only sensed if his heart missed beats, but also controlled how frequently it beat and could also shock his heart back into a normal rhythm if he were to have another cardiac arrest.
After discharge a team of rehabilitation physios worked on him to get him up to working again and playing football with his grandson. His GP provided ongoing care, reassurance and a point of contact where all the specialists he needed could feed in.
Ten years ago, he would have died. Now he can live a full life, thanks to the advances in technology and increased funding for the NHS. At no point in this scenario did we stop to question if he had insurance or if he could pay for the treatment he received. We did not care if he was a millionaire or on the dole. All we wanted was to give him the best possible chance to walk out of the hospital, not only alive but in good enough shape to live a normal life again. This is possible because of the way the NHS works – it is free to whoever needs it regardless of ability to pay and with co-operation and not competition between the many different health care professionals and services. Thanks to the NHS he lives to fight another day. It was great to be a small cog in his care 4 months ago. It is great he has been well enough to go out and break his ankle.